Membership Application

Klamath Art Association and Gallery 
Membership Application/Renewal Form
& Address Change Notification

The Klamath Art Gallery is a non-profit membership supported gallery. Every member is a valuable supporter!
Membership benefits are huge! Networking within the community, and learning about statewide opportunities to view and sell artwork or photography keep KAA members extremely well informed.
Please fill in the information below and make a check payable to the Klamath Art Association. Mail this form to:   
                              
Klamath Art Association
P.O. Box 955
Klamath Falls, OR   97601                       Please print:

Name:_____________________________
Street:_____________________________
City:______________________________
State:___________________ZIP________
Phone#____________________________
E-mail:_____________________________
Web site:___________________________***see below
Circle one:  Non-Artist     Practicing artist
Artists only: Media(s)_________________
___________________________________
Date Paid:__________________________
Signature:__________________________

Dues and Donations: 
Senior (over 60/student:  $ 30___________              
Single                              $ 35___________
Family                             $ 45___________
Business  Partner             $ 50   _________   
Patron                              $ 60    _________
Bronze Patron               $ 100    _________
Silver Patron                 $ 250   _________ 
Gold Patron                  $ 500    _________
Platinum Patron         $ 1,000   _________
Donation:                                 _________
Web site link to KAA   $ 5.00________________per year.***
***Web site Name and URL:  Write on back. 
Total due:                                  ______________
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Attn.: The Treasurer sends these forms to the membership chairperson, so members need to fill them out accurately and completely each time they join or renew. The KAA Privacy Policy prohibits officers and board members from divulging your personal information.